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EMERGENCY MEDICINE

Etomidate for Procedural Sedation in the Emergency Department

at time of writing, PharmD Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; now, Clinical Pharmacy Specialist, Adult Intensive Care Unit, Royal Jubilee Hospital/Victoria General Hospital, Victoria, British Columbia, Canada

Peter J Zed, PharmD

Pharmacotherapeutic Specialist—Emergency Medicine, CSU Pharmaceutical Sciences, Vancouver General Hospital; Clinical Assistant Professor, Faculty of Pharmaceutical Sciences; Associate Member, Department of Surgery, Faculty of Medicine, University of British Columbia

Reprints: Peter J Zed PharmD, CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 W. 12th Ave., Vancouver, BC V5Z 1M9, Canada, fax 604/875-5267, zed{at}interchange.ubc.ca

OBJECTIVE: To review the current efficacy and safety evidence for the use of etomidate for procedural sedation in the emergency department (ED).

DATA SOURCES: MEDLINE (1966–December 2003), EMBASE (1980–December 2003), PubMED (1966–December 2003), and Cochrane Database of Systemic Reviews (up to December 2003) were searched for full-text reports published in English on the use of etomidate in humans. Search terms included etomidate, procedural sedation, conscious sedation, relocation, dislocation, abscess incision, abscess drainage, and cardioversion.

STUDY SELECTION AND DATA EXTRACTION: Prospective and retrospective studies evaluating efficacy or safety endpoints using etomidate for procedural sedation in the ED were included. All studies were evaluated independently by both authors. For clinical outcomes (efficacy, safety), the definitions specified by each study were used.

DATA SYNTHESIS: Three observational studies and 5 prospective, randomized controlled trials were included in this review. Onset of action and time to recovery following etomidate were rapid and found to be comparable to that of propofol and thiopental but significantly faster than that of midazolam. The dose of etomidate for procedural sedation ranged from 0.15 to 0.22 mg/kg. No significant hemodynamic effects were observed; however, respiratory depression resulting in oxygen desaturation to <90% or apnea appears to occur in approximately 10% of patients undergoing procedural sedation with etomidate with or without analgesia. The most prominent adverse effect reported with etomidate was myoclonus, occurring in 20–45% of patients.

CONCLUSIONS: Etomidate is an appropriate and valuable agent for performing procedural sedation in the ED. The rapid onset and recovery time and relative lack of significant hemodynamic and respiratory effects may facilitate optimal and safe conditions for procedural sedation in the ED.

Key Words: conscious sedation, emergency department, etomidate, procedural sedation

Published Online, June 1, 2004. www.theannals.com, DOI 10.1345/aph.1E008

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